Outcomes in patients ≥80 years with a diagnosis of a hepatopancreaticobiliary (HPB) malignancy

Introduction: Older patients are underrepresented in oncological clinical trials. The incidence of hepatopancreaticobiliary (HPB) malignancies is higher in older patients, but data on outcomes is lacking. Objectives: This study assessed patient outcomes in those <80 and ≥80 years with a HPB malignancy seen at a tertiary referral centre, The Christie NHS Foundation Trust. Methods: Data on patients with a HPB malignancy were collected retrospectively between 2012 and 2017 via on-line case-note review. Survival was calculated using the Kaplan-Meier method and prognostic factors using log rank analysis. Results: Of 1421 patients, 10% were ≥80 years. Of patients <80 and ≥80 years, 56% and 57% had pancreas cancer, 39% and 36% biliary tract cancer, and 5% and 7% had hepatocellular carcinoma respectively. Amongst patients ≥80 years, 75% had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2. Patients ≥80 years had higher rates of co-morbidity; 28% received systemic anti-cancer therapy (SACT), compared with 62% of patients <80 years. Best supportive care (BSC) was instituted in 44% of older patients, compared with 13% in those <80 years. Of patients ≥80 years who received SACT, 82% received monotherapy. Median overall survival (OS) for patients receiving palliative SACT was 10.07 months (95% CI 8.89-11.08) and 10.10 months (95% CI 6.30-12.30) in patients <80 and ≥80 years, respectively, p 0.41; ECOG PS (p<0.001) was prognostic for OS in older patients but Adult Comorbidity Evaluation-27 co-morbidity score (p=0.07, when comparing groups of ACE score <=1 and >1) was not. Conclusions: Baseline factors were similar in both age cohorts, but more co-morbidities were present in older patients. Older patients were less likely to receive SACT, but when they did, they had an equivalent benefit in OS to younger patients.